Jessica Peck, MAc, LAc, MS-PREP candidate presented her capstone research project on December 9, 2011 to a group of students, faculty members and invited guests at the Tufts University School of Medicine. Jessica initiated an ambitious, ongoing study for her capstone project which is being conducted at the Maine Medical Center’s Palliative and Supportive Care Clinic. The focus of her pilot research study is the implementation and evaluation of the feasibility of using acupuncture plus standard care to treat pain and associated symptoms in cancer patients. Jessica will continue to work with her capstone preceptor, Dr. Lauren Michalakes, Director of Palliative Care at Maine Medical Center as her study progresses.

The Pain Research Education and Policy Program at Tufts University School of Medicine educates thought leaders in the multidisciplinary area of pain. This is evident by the efforts of two PREP program graduates, one a current Tufts PREP program faculty member and the other a practicing acupuncturist, through their collaborative research concerning endometrial pain and acupuncture. PREP graduates, Ewan McNichol and Kindreth Hamilton, along with co-author Xiaoshu Zhu, recently published a systematic intervention review; Acupuncture for Pain in Endometriosis in the Cochrane Library. In this systematic review, twenty-four studies were identified that involved acupuncture for endometriosis. One trial, enrolling 67 participants, met all the inclusion criteria. The authors concluded: “The evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review. This review highlights the necessity for developing future studies that are well-designed, double-blinded, randomized controlled trials that assess various types of acupuncture in comparison to conventional therapies.”

The PREP program applauds our graduates for their continued thought leadership surrounding the global issues of pain research, education and policy.

The PREP Community here at Tufts is pleased to announce our most recent capstone presentations. Come to the Tufts Health Sciences Campus, 136 Harrison Ave, Boston, M&V conference room 1, on Monday, May 2 at 3:30pm to both hear from two of our nurse graduates and to enjoy a reception following.

Carol Krieger, RN, BSN, LicAc, MAOM: Development of a research proposal for the effectiveness of acupuncture as a treatment of central and neuropathic pain syndromes from polytrauma – spinal cord injury, traumatic brain injury, and phantom limb pain

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thanks to MS-PREP alumna, Xu Cheng, for sending along a link to a recent issue of Nature Neuroscience which highlights a study on acupuncture’s pain reducing effect. In animal studies, the neuromodulator adenosine appears to play a significant role in the local anti-nociceptive properties of acupuncture. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture Click here to read the abstract of the study

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thank you to 2010 MS-PREP alumna, Nancy Mitchell, for sending along a recent update to the Cochrane Library and the Cochrane Database of Systemic Reviews addressing acupuncture and tension-type headaches. In a previous Cochrane Review (2001), acupuncture was found to be inconclusive as a treatment for tension-type headaches. However an updated 2009 Cochrane Review on acupuncture and tension-type headaches, which included 11 randomly controlled trials, concluded that acupuncture may be a valuable treatment option for patients suffering from frequent tension-type headaches.The Cochrane Review stated: “We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.”
Cochrane Reviews are an integral part of evidence based medicine. It is important to include both allopathic and integrative medicine studies in the rigorous review process to further our knowledge of effective strategies to treat and manage chronic pain conditions.

by Jessica Gerber, M.Ac., Lic. Ac., MS-PREP
Another article about acupuncture and low back pain…Though this one focuses on pregnant women.
HealthDay News recently reported: “A week of continuous auricular acupuncture can reduce pain and disability in pregnant women with low back and posterior pelvic pain, according to a study published in the September issue of the American Journal of Obstetrics & Gynecology“
“Shu-Ming Wang, M.D., of the Yale School of Medicine in New Haven, Conn., and colleagues conducted a randomized, controlled trial of 152 women at 25 to 38 weeks’ gestation who had lower back pain, posterior pelvic pain or both, and were given either acupuncture or sham acupuncture, or put on a waiting list (control group). The subjects were then monitored for two weeks.”
“Compared with those in the sham acupuncture and control groups, women receiving auricular acupuncture reported the best results, the researchers discovered. At the seven-day mark, about 80 percent of the acupuncture group reported a clinically significant reduction in pain, whereas only 56 percent of the sham acupuncture group and 36 percent of those in the control group did. However, the authors note, for some of the participants, the benefits were not sustained.”
“Long-term efficacy of auricular acupuncture as a treatment for pregnancy-related low back and posterior pelvic pain is still inconclusive but clearly shows promise,” Wang and colleagues conclude. “A future large-scale randomized control study is indicated to explore the characteristics of acupuncture responders versus non-responders [and] the optimal duration of treatment to achieve the sustained therapeutic effect.”

by Daniel Carr, M.D., FABPM, Founding Director of the Pain Research, Education and Policy Program, Tufts University School of Medicine, and Pamela Katz Ressler, RN, BSN, HNC, MS-PREP student and PREP-AIRED blog moderator
Every academic field has a handful of texts that are classic, definitive reference works. For pain medicine and regional anesthesia the textbook first prepared by Michael Cousins and Philip Bridenbaugh in 1988, Cousins and Bridenbaugh’s Neural Blockade in Clinical Anesthesia and Pain Medicine, has enjoyed worldwide success as one of the most, if not the most, comprehensive and authoritative monographs on these topics. Professor Cousins has pioneered in the development of pain research and treatment in Australia, and is a Past President of the International Association for the Study of Pain. During his tenure as IASP President he formed a Task Force on Pain Curricula whose recommendations have influenced pain education around the world — including Tufts’ PREP program. Dr Bridenbaugh is Past President of the American Society of Anesthesiologists and also the American Society of Regional Anesthesia.
About five years ago Professors Cousins and Bridenbaugh approached Dr Dan Carr, Founding Director of the PREP program, and Professor Terese Horlocker of the Mayo Clinic to join them as co-editors for the fourth edition of this text. Dr Carr is happy to report that the text has now been published! Compared to the prior edition, the number of chapters has expanded from 34 to 51, and the total number of authors from 52 representing 9 countries to 90 (including 68 new ones) representing 15 countries. Of note for those with an interest in acupuncture, it is the first text on regional anesthesia to include a chapter on the effects of needle insertion per se, by two Western physicians who studied acupuncture with Professor Han in Beijing. The book also includes chapters on placebo, psychological aspects of pain, and pain mechanisms.
The very first user review on Amazon’s website states “This edition has been almost rewritten and [a] larger portion is dedicated to pain management and basic pain mechanisms.
Indispensable reference!”

Discussion about international collaboration between Xiaoshu Zhu (University of Western Sydney, Australia), Ewan McNichol (PREP program faculty, TUSM) and MS-PREP program graduate and acupuncturist, Kindreth Hamilton